American Indians and Alaska Natives (ALAN) suffer from some of the highest rates of diabetes in the world, and of most concern is the increasing prevalence of type 2 diabetes in AlAN children and young adults. T he rising problem of diabetes in children was first recognized by the National Institutes of Health in their research involving the Pima Indians in the 1970s, and is now well documented as a national trend with Indian Health Service (illS) prevalence data. The IHS National Diabetes Program monitors diabetes care through the annual IHS Diabetes Care and Outcomes Audit, but there are currently no published studies of the quality of diabetes care for AlAN children and young adults. In 1997, Congress funded the Special Diabetes Program for Indians initiative to implement new prevention and treatment services for American Indians and Alaska Natives, and many Indian health programs have implemented services to improve the quality of care for children and young adults with diabetes. Given the availability of the IHS Diabetes Care and Outcomes Audit data and administrative data from the Special Diabetes Program for Indians initiative, this study will address the following specific aims: 1 ) Determine the quality of diabetes care for American Indian and Alaska Native children and young adults using the IHS Diabetes Care and Outcomes Audit 2) Determine if programmatic interventions for children and young adults under the Special Diabetes Program for Indians initiative are associated with better diabetes care This study will have immediate programmatic and clinical relevance as it will be the first study of its kind to document the quality of diabetes care for AlAN children and young adults and will attempt to evaluate whether interventions for these age groups are associated with better diabetes care. The results of this study will provide important, specific information on diabetes care that will be useful for both Indian health programs and programs serving other populations facing the growing epidemic of diabetes in children and young adults.